Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 29653 | MN |
NPI | 1093774549 |
---|---|
Provider Name | Stanley A Skinner |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A94257 | (02) |